Are There Benefits of Using Energy-based Devices for Opportunistic Salpingo-oophorectomy During Vaginal Hysterectomy Compared to a Standard Cold Approach?

Vaginal hysterectomy is a common surgical procedure performed for benign gynecologic indications, including pelvic organ prolapse. Opportunistic salpingectomy, with or without oophorectomy, is increasingly recommended at the time of hysterectomy in women at average risk for ovarian cancer, as it may reduce future cancer risk without increasing surgical morbidity. During vaginal hysterectomy, salpingo-oophorectomy can be performed using a conventional surgical technique involving clamping, cutting, and suturing, or by using energy-based vessel sealing devices.

Energy-based devices, such as the LigaSure Maryland, have been shown in other gynecologic procedures to reduce operative time, blood loss, and length of hospital stay. However, there are limited data comparing energy-based versus conventional techniques specifically for opportunistic salpingo-oophorectomy performed during vaginal hysterectomy.

This prospective, randomized controlled study is designed to compare an energy-based technique using the LigaSure Maryland device with a standard "knot-and-cut" technique for opportunistic salpingo-oophorectomy during vaginal hysterectomy for benign indications.

Women scheduled to undergo vaginal hysterectomy for pelvic organ prolapse, for whom salpingo-oophorectomy is recommended according to standard clinical indications, will be eligible for participation. After providing informed consent, participants will be randomly assigned to one of two parallel groups. In the intervention group, salpingo-oophorectomy will be performed using the LigaSure Maryland energy-based vessel sealing device. In the control group, salpingo-oophorectomy will be performed using the standard surgical technique of clamping, cutting, and suturing.

Randomization will be performed prior to surgery using a computerized randomization tool. Participants will be blinded to the surgical technique used. Surgeons will not be blinded due to the nature of the interventions.

The primary outcome of the study is the duration of the salpingo-oophorectomy procedure, measured from completion of the vaginal hysterectomy and the decision to proceed with salpingo-oophorectomy until removal of the fallopian tube and ovary specimen on both sides. Secondary outcomes include estimated blood loss during the procedure, postoperative pain assessed using a visual analog scale (VAS), length of postoperative hospital stay, and the rate of intraoperative and postoperative complications.

Both surgical techniques are considered standard of care and are commonly used in modern gynecologic surgery. Patient safety is not expected to be compromised by participation in either study group. In cases where deviation from the assigned surgical technique is required intraoperatively due to anatomical or technical considerations, the participant will be excluded from the final analysis to avoid bias.

The results of this study aim to provide evidence regarding the safety and efficacy of energy-based opportunistic salpingo-oophorectomy during vaginal hysterectomy and may help guide surgical decision-making in clinical practice.

Inclusion criteria

• Women aged 18 years or older.
• Scheduled to undergo vaginal hysterectomy for pelvic organ prolapse.
• Recommended to undergo opportunistic salpingo-oophorectomy according to standard clinical indications.
• Able and willing to provide written informed consent.

Exclusion criteria

• Suspected or known pelvic malignancy.
• Lack of informed consent.
• Planned opportunistic salpingo-oophorectomy using a non-vaginal surgical approach.
• Planned opportunistic salpingo-oophorectomy using a vNOTES (vaginal natural orifice transluminal endoscopic surgery) approach.
• Intraoperative need to deviate from the assigned surgical technique due to anatomical or technical considerations.